A Cohort Study of Missed and New Cancers After Esophagogastroduodenoscopy

Raftopoulos, Spiro; Segarajasingam, Dev S.; Burke, Valerie; Ee, Hooi C.; Yusoff, Ian F.

doi:10.1038/ajg.2009.736

Cited by 94 publications

(107 citation statements)

References 20 publications

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“…This finding is in line with that of prior non-US studies [3][4][5][6] , with the exception of those from Japan [1,2] . The western population may differ from the Japanese population in terms of risk factors, including Helicobacter pylori infection and gastric intestinal metaplasia, and therefore gastric cancer prevalence.…”

Section: Discussionsupporting

confidence: 83%

“…Similar to the literature on interval upper GI cancers after EGD [1][2][3][4][5][6] and CRCs after colonoscopy [8][9][10][11] , we categorized upper GI cancers diagnosed within 6 months of an EGD as detected cancers and upper GI cancers diagnosed 6-36 months after an EGD as interval cancers. The patient was the unit of analysis.…”

Section: Methodsmentioning

confidence: 96%

“…Better understanding of the underlying reasons for interval upper GI cancers after EGD will help improve cancer detection, facilitate earlier treatment, and likely lead to better outcomes, considering the worse prognosis of esophageal and gastric cancers compared to the prognosis of colorectal cancers. In the recent Western Australian study, about 70% of the patients with interval cancers had abnormalities noted during the initial EGD, and over 60% of these patients had alarm symptoms such as anemia, weight loss, or dysphagia [6] . Diligent follow-up on abnormalities found during EGD, and a low threshold to repeat EGD if symptoms persist, may lead to earlier diagnosis [7] .…”

Section: Discussionmentioning

confidence: 99%

“…Patients with more than 2 EGDs performed during the 36 months were excluded to minimize the confounding effect of incomplete procedure or inadequate examination. Similar to the recent Australian study [6] , patients with achalasia (ICD-9 code 530.0) or Barrett's esophagus (530.85), who are at higher risks for interval esophageal cancer, were also excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Data from Japan, the United Kingdom, and Finland reported interval cancer rates of 7-26% [1][2][3][4][5] . A recent study of 28,000 patients who underwent esophagogastroduodenoscopy (EGD) at a hospital-based endoscopy unit in Perth, Western Australia reported an interval cancer rate of up to 6.7%, paralleling colonoscopy [6,7] .…”

Section: Introductionmentioning

confidence: 99%

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Rate and Predictors of Interval Esophageal and Gastric Cancers after Esophagogastroduodenoscopy in the United States

et al. 2016

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Background and Aims: In the United States, little is known about the rates of interval upper gastrointestinal (GI) cancer (possibly missed out) after an esophagogastroduodenoscopy (EGD) is performed. Data from non-US studies reported interval cancer rates of 7-26%. We aimed to study the rate and predictors of interval upper GI cancers in the United States. Methods: Using the random 5% sample of Medicare beneficiaries in the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified patients diagnosed with esophageal or gastric cancer during 2000-2007. EGD performed within 36 months prior to cancer diagnosis was identified using CPT codes. Cancers diagnosed 6-36 months after EGD were defined as interval (vs. detected) cancers. The chi-square test and the multivariate logistic model were used in statistical analysis. Results: Of 751 patients diagnosed with upper GI cancer, 52 patients (6.9%) were diagnosed with interval cancers 6-36 months after EGD. The rate of interval cancers was 5.5% (31/568) for gastroenterologists and 11.5% (21/183) for non-gastroenterologists (p < 0.01). In multivariate logistic regression, EGDs performed by gastroenterologists (vs. non-gastroenterologists: OR 0.46, 95% CI 0.25-0.83) and those in inpatient setting (vs. outpatient: OR 0.53, 95% CI 0.28-0.997) were associated with a lower likelihood of interval cancers. Sensitivity analyses limited to outpatient EGDs or interval cancers 6-30 months after EGDs led to similar results. Conclusions: The rate of interval cancers after EGD is the same as the rate of colonoscopy among Medicare patients in the United States. EGDs performed by gastroenterologists and in in-patient settings were associated with a lesser likelihood of interval cancers.

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Section: Discussionsupporting

confidence: 83%

Section: Methodsmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rate and Predictors of Interval Esophageal and Gastric Cancers after Esophagogastroduodenoscopy in the United States

et al. 2016

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Quality indicators in the endoscopic detection of gastric cancer

Namasivayam

Uedo

2023

DEN Open

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Gastroscopy is the reference standard for the diagnosis of gastric cancer, but it is operator‐dependent and associated with missed gastric cancer. The proliferation of gastroscopic examinations, increasingly for the screening and detection of subtle premalignant lesions, has motivated scrutiny of quality in gastroscopy. The concept of a high‐quality endoscopic examination for the detection of superficial gastric neoplasia has been defined by expert guidelines to improve mucosal visualization, engender a systematic examination process and detect superficial neoplasia. This review discusses the evidence supporting the components of a high‐quality diagnostic gastroscopic examination in relation to the detection of gastric cancer, and their potential role as procedural quality indicators to drive a structured improvement in clinically meaningful outcomes.

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Visibility of early gastric cancer in texture and color enhancement imaging

Abe¹,

Yamazaki²,

Hisada³

et al. 2021

DEN Open

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Objective There are little data regarding the efficacy of texture and color enhancement imaging (TXI) for early gastric cancer (EGC) diagnosis. This study aimed to compare the color difference and visibility of EGC between white light imaging (WLI) and TXI. Methods This study included 20 EGCs of 18 patients undergoing endoscopic submucosal dissection. Still images of EGC in WLI, TXI mode 1 (with color enhancement), and TXI mode 2 (without color enhancement), which were consistent in distance, angle, and air insufflation, were constructed by computer simulation. The center of the lesion, eight equal peripheral points 5 mm outside the lesion, and eight inner points two‐thirds of the distance from peripheral points to the EGC lesion center were annotated. Mean color differences (ΔE) of the area between peripheral and inner points per lesion in WLI, TXI mode 1, and TXI mode 2 were analyzed. In addition, four endoscopists independently scored the visibility of EGC images of TXI mode 1 and 2 compared with WLI. Results Clinicopathological characteristics were as follows: 0‐IIa/0‐IIb/0‐IIc/0‐IIa+IIc = 6/1/11/2, reddish/pale = 10/10, differentiated/undifferentiated = 18/2, median tumor size = 13.5 mm. Mean ΔE ± SD = WLI/TXI mode1/TXI mode2 = 10.3 ± 4.7, 15.5 ± 7.8, and 12.7 ± 6.1, respectively. Mean ΔE was significantly higher in TXI mode 1 than in WLI. Visibility (improved/no change/decreased) was 7/13/0 and 4/16/0 in TXI mode 1 and 2, respectively. The visibility was significantly more commonly improved in the macroscopic type 0‐IIc or 0‐IIb than in 0‐IIa or IIa+IIc in TXI mode 1. Conclusions TXI could improve the visibility of EGC compared with WLI.

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A Cohort Study of Missed and New Cancers After Esophagogastroduodenoscopy

Abstract: UGC is rare after normal EGD, confirming the high accuracy of EGD. Institutional approval was granted for the conduct of this study.

Cited by 94 publications

References 20 publications

Rate and Predictors of Interval Esophageal and Gastric Cancers after Esophagogastroduodenoscopy in the United States

Rate and Predictors of Interval Esophageal and Gastric Cancers after Esophagogastroduodenoscopy in the United States

Quality indicators in the endoscopic detection of gastric cancer

Visibility of early gastric cancer in texture and color enhancement imaging

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